Clearance Specialist

Soleo Health Inc•Frisco, TX

6d•Remote

About The Position

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Acute home infusion experience required, and must be able to work 8:30a-5p Mountain Time. The Clearance Specialist will be working 8:30am -5:00pm MST, and is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs. They will also be responsible for preparation, submission, and follow up of payer authorization requests. Responsibilities include:

Requirements

High school diploma or equivalent
At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience preferred
Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units
Strong ability to multi-task and support numerous referrals/priorities while ensuring productivity expectations and quality are met
Ability to work in a fast-paced environment
Knowledge of HIPAA regulations
Basic level skill in Microsoft Excel & Word
Knowledge of CPR+ preferred
Must be able to work Full time, 40 hours per week, from 8:30a-5pm Mountain Time
Weekend On-call once monthly
Must have experience with Acute Infusion for Prior authorization/Benefits Verification

Responsibilities

Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services
Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc
Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing
Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including
Reviewing and obtaining clinical documents for submission purposes
Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed
Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations
Generate new patient start of care paperwork